VASOSPASM IN SUBARACHNOID HEMORRHAGE - PH ARMACOLOGICAL TREATMENT

Pharmacological treatment of vasospasm in subarachnoid haemorrhage (SA H) is founded on prevention and treatment of arterial narrowing and de layed ischaemic deficits. Safety and efficacy of different agents have been studied and trials classified according to the level of evidence proposed by the ''Stroke Council'' of the American Heart Association. Early intracisternal fibrinolysis can prevent vasospasm (level III to V of evidence, grade C). Pharmacological treatment is based on few dr ugs. Nimodipine reduces poor outcome related to vasospasm, but does no t affect angiographic vessel caliber (level of evidence I and II, grad e A). Its use is strongly recommended. Nicardipine decreases symptomat ic and angiographic vasospasm, but does not affect outcome (level of e vidence I to V, grade B). Tirilazad associated with nimodipine prevent s delayed ischaemic deficits due to vasospasm and improves outcome in male patients. Intra-arterial infusion of papaverine associated with t ransluminal angioplasty can improve symptomatic vasospasm, resistant t o conventional therapy (level of evidence IV to V, grade C), Pharmacol ogical treatment of vasospasm associated with specific management foun ded on pathophysiology of SAH has improved patients outcome.